Moving on from bland: the evolution of the law and minimally conscious patients

The decision in Bland centred on the withdrawal of artificial nutrition and hydration from a patient in a persistent vegetative state (PVS). Since then, a new medical condition has emerged, known as a minimally conscious state (MCS). In W v M, the Court of Protection was asked to authorise the withdrawal of artificial nutrition and hydration from a patient in a MCS. Baker J refused to grant the declaration. More recently, however, the courts were also asked to rule on the lawfulness of withholding treatment in a similar, albeit factually different, case. In the Court of Appeal decision in Aintree University Hospitals NHS Foundation Trust v David James and Others, Sir Alan Ward, with the agreement of Arden LJ and Laws LJ, granted a declaration that it would be lawful to withhold treatment. The Supreme Court then upheld this ruling, Lady Hale stating that the Court of Appeal reached the right result but for the wrong reasons. This article seeks to critically appraise the evolution of the law in regard to withdrawing treatment from MCS patients. The piece begins by explaining the differences between the two conditions of PVS and MCS and defines the law from the starting point of Bland. From here, the discussion progresses to focus on the challenges that the law has had to face in trying to keep pace with the advancing nature of medical understanding of conditions of the brain and explains how it has responded to these. The narrative then critiques the legal mechanism of best interests as it has been employed in the case law concerning MCS patients to date by analysing the various judicial perspectives on the concept. After addressing both the narrow and wide viewpoints, a conclusion is ventured as to how the balancing of best interests should be approached in respect of future MCS cases.